Süleyman Kaynak

Prevention of posterior capsule opacification by intraoperative single-dose pharmacologic agents

Purpose: To determine whether an intraoperative single dose of dexamethasone, diclofenac, ethylenediaminetetraacetic acid (EDTA), a combination of EDTA and RGD peptide (arginine‐glycin‐aspartic acid sequence), or mitomycin‐C (MMC) is a pharmacological means of preventing or reducing the development of posterior capsule opacification (PCO). Setting: Department of Ophthalmology, Celal Bayar University, School of Medicine, Manisa, and Department of Pathology, Dokur Eylül University, School of Medicine, Izmir, Turkey. Methods: Fifty‐four rabbits were randomly divided into 6 groups. Dexamethasone (4 mg/cc), diclofenac (2.5 mg/cc), EDTA (8 mg/cc), a combination of EDTA and RGD peptide (2.5 mg/cc), or MMC (0.04 mg/cc) was given, 0.1 cc by hydrodissection and 0.9 cc into the capsular bag after phacoemulsification. The sixth group served as a control group. After 3 months, the PCO was graded clinically and the proliferation of lens epithelial cells (LECs) was evaluated histologically. Results: The drugs were significantly effective in preventing PCO compared with the control (P < .005). Dexamethasone had a weaker effect than the other drugs. In histological analysis, although monolayer LECs in the dexamethasone and diclofenac groups were observed, there was no proliferative activity on the posterior capsules in the EDTA, EDTA+RGD, and MMC groups in contrast to the multilayer cells in the control. Conclusions: Intraoperative single‐dose application of EDTA, EDTA+RGD peptide combination, and MMC significantly prevented the development of PCO in rabbit eyes. Diclofenac was less effective but also reduced PCO. Although dexamethasone did not prevent the proliferation of LECs, it decreased PCO clinically.

Tilt and decentration after primary and secondary transsclerally sutured posterior chamber intraocular lens implantation

Purpose: To evaluate tilt and decentration after primary and secondary implantation of transsclerally sutured posterior chamber intraocular lenses (PC IOLs). Setting: Dokuz Eylül University Medical School, Department of Ophthalmology, Idot;;zmir, Turkey. Methods: Fifty‐six consecutive eyes of 53 patients who had implantation of transsclerally sutured PC IOLs were prospectively included in the study. Intraocular lens tilt and decentration after primary (14 eyes) and secondary (42 eyes) implantation were compared quantitatively using Purkinje images. Results: The mean IOL tilt was 6.09 degrees ± 3.80 (SD) in all eyes, 5.71 ± 3.41 degrees in the primary implantation group, and 6.22 ± 3.94 degrees in the secondary implantation group. The mean IOL decentration was 0.67 ± 0.43 mm (range 0 to 2.5 mm), 0.59 ± 0.38 mm, and 0.69 ± 0.45 mm, respectively. There were no statistically significant differences between the primary and secondary implantation groups in decentration or tilt. Decentration greater than 1.0 mm was present in 7 eyes (16.7%) after secondary implantation and in 1 eye (7.1%) after primary implantation. Tilting of more than 10 degrees was present in 7 eyes (16.7%) and 2 eyes (14.2%), respectively. There were no statistically significant differences between the 2 groups in decentration greater than 1.0 mm (chi square = 0.194, P = .834) or in tilting greater than 10 degrees (chi square = 0.834, P = .659). Conclusions: Clinically significant IOL tilt or decentration was rare after transscleral implantation. There were no differences in tilt or decentration between primary and secondary implantation.

Pseudoexfoliation and glaucoma in eyes with retinal vein occlusion

Purpose: To evaluate pseudoexfoliation (PE) and pre-existent glaucoma in eyes with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Methods: Consecutive eyes with a diagnosis of BRVO (73 eyes of 70 patients) and CRVO (53 eyes of 49 patients) examined between July and December 1998 comprised the study eyes. Age-matched control group consisted of 384 eyes of 192 outpatients. The prevalence of PE and glaucoma were determined and appropriate statistical tests were performed. Results: PE was present in six of 73 eyes with BRVO (8.2%), 11 of 53 eyes with CRVO (20.8%) and 20 of 384 control eyes (5.2%). Two of 73 eyes with BRVO (2.7%) and 10 of 53 eyes with CRVO (18.9%) had glaucoma. Compared with the control eyes, PE was significantly more common in eyes with CRVO and coexistent glaucoma was significantly more common both in eyes with CRVO and in eyes with BRVO. Conclusion: While glaucoma seems to be a risk factor both for BRVO and CRVO, PE is a likely risk factor for CRVO.

Pars plana vitrectomy with pars plana tube implantation in eyes with intractable glaucoma

AIMS Intractable glaucoma is glaucoma resistant to medical therapy and conventional surgical procedures. In this study, a planned surgical technique is discussed for controlling the increased intraocular pressure in selected cases with intractable glaucoma. METHODS Total pars plana vitrectomy with pars plana tube implantation was performed in 17 eyes of 17 cases with intractable glaucoma. Patients with neovascular glaucoma were not included in this study. The mean age of these patients (seven men, 10 women) was 44.6 (SD 22.1) years and mean follow up period was 30.3 (15.5) months (range 4–71). Drainage implants with a disc were used in 16 cases, whereas, a tube with scleral buckle (Schocket surgery) was preferred in one case. An intraocular pressure below or equal to 20 mm Hg without any adjunctive medication or with only one type of antiglaucomatous drop was considered as an adequate operative outcome. RESULTS 16 out of 17 eyes maintained adequate pressure control. Only three out of these 16 eyes required prophylactic antiglaucomatous medications. One patient underwent reoperation for pressure control. The most severe complications observed postoperatively were intravitreal haemorrhage (one case), choroidal detachment (one case), implant failure (one case), total retinal detachment (two cases), and corneal endothelial decompensation (five cases). CONCLUSION Pars plana placement of drainage tube following pars plana vitrectomy should be considered as an alternative method for controlling increased intraocular pressures in selected patients with intractable glaucoma.

Unilateral Purtscher-like retinopathy after weight-lifting

Purpose To report a case of Purtscher-like retinopathy after weightlifting. Methods A 17-year-old man presented with a sudden visual loss in his left eye after weightlifting two weeks ago. Fundus examination of the left eye showed cotton-wool spots and scattered retinal hemorrhages in the posterior pole. Fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were performed. Results Angiography showed hypofluorescent areas adjacent to the optic disc and in the posterior pole and partial filling insufficiency in the inferior and inferotemporal branch retinal veins. Complete venous filling was noted in late phases of angiography. Conclusions The pathogenesis of weightlifting suggests the Purtscher-like changes as a result of Valsalva maneuver in our case. To our knowledge, this is the first reported case of Purtscher-like retinipathy associated with weightlifting.

Magnetic resonance imaging and computed tomography in the detection and localization of intraocular foreign bodies

In this experimental study, various foreign bodies were inserted into fresh bovine eyes, in different localizations. Twenty-one magnetic and non-magnetic foreign bodies, dimensions of which varied from 1.5 × 1.5 × 2 mm to 3.5 × 6 × 7 mm, were tried to detect by computed tomography (CT) and magnetic resonance imaging (MRI) scanning. In addition, further dissections were applied to check the ocular damage attributable to movement of the foreign bodies. Ferromagnetic foreign bodies have been shown to move in the eye and the risk of torsional forces being applied to the ferromagnetic foreign body seemed to cause intraocular complications during MRI scanning. All of the foreign bodies that were implanted in bovine eyes were recognized on CT scanning, except intraocular lenses. As a general rule, metallic foreign bodies produced beamhardening artifacts, but these artifacts did not cause any problem in detecting the localizations of foreign bodies.

Transscleral fixation of foldable intraocular lenses

Purpose: To report the results of transscleral implantation of foldable intraocular lenses (IOLs). Setting: Department of Ophthalmology Dokuz Eylül University School of Medicine, Izmir, Turkey. Methods: Twenty eyes of 20 patients had transscleral fixation of a foldable IOL combined with conventional 3‐port pars plana vitrectomy or anterior vitrectomy. Twelve eyes had lens luxation, 8 traumatic and 4 idiopathic. Six eyes were aphakic, 3 after extracapsular cataract extraction and 3 as a result of complicated phacoemulsification. One patient with a mature cataract and pseudoexfoliation had a wide zonular dialysis during phacoemulsification. One patient had an opacified hydrophilic acrylic IOL. Results: The mean age of the patients was 52.9 years (range 17 to 80 years). The mean preoperative best corrected visual acuity (BCVA) was 20/63 (range counting fingers to 20/25). The mean preoperative refraction was +10.8 diopters (D) (range +10 to +13 D) and the mean preoperative astigmatism, 1.8 D (range 1.0 to 5.5 D). Sixteen IOLs were hydrophobic acrylic, 14 of which were 3‐piece AcrySof® MA60BM (Alcon) and 2 of which were Sensar® AR40 (Allergan). Four IOLs, all VisaAcryl® (Staar), were hydrophilic acrylic. The mean power of the IOLs was +22.0 D (range 19.0 to 26.0 D). The mean follow‐up was 12 months (range 1 to 18 months). The postoperative BCVA ranged between 20/100 and 20/20, and the mean postoperative astigmatism was 1.1 D (range 0.5 to 4.0 D) at the last follow‐up visit. The difference was statistically significant (P<.05). Suture exposure and cystoid macular edema were the only complications, each occurring in 2 eyes. Conclusion: Transscleral fixation of foldable IOLs takes less time and results in fewer complications and better visual outcomes.

Preserved human amniotic membrane transplantation in the treatment of primary pterygium.

BACKGROUND AND OBJECTIVE To assess the outcome of simple excision with preserved human amniotic membrane transplantation in the treatment of primary pterygium. PATIENTS AND METHODS A total of 59 eyes with primary pterygium underwent surgical excision. In Group 1, 28 eyes were treated with simple excision and preserved human amniotic membrane transplantation. In Group 2, 31 eyes were treated with bare sclera excision. These two groups were compared in recurrence, final appearance of the operation site, and complications. Patients were followed for at least 10 months. RESULTS During a mean follow up of 14.9 months, we observed 3 (10.7%) recurrences in Group 1 and 20 (38.7%) recurrences in Group 2 (P:0.03). In Group 1, 20 (71.4%) eyes and 14 (45.2%) eyes in Group 2 had a satisfactory final operation site appearance (P:0.041). No serious complication was observed in both groups. CONCLUSION Simple excision and preserved human amniotic membrane transplantation appears to be a safe and effective way of treating primary pterygium because of the lack of serious complications and a relatively low rate of recurrence.

Staining of vitreous with triamcinolone acetonide in retained lens surgery with phacofragmentation

PURPOSE: To evaluate the beneficial effects of triamcinolone‐assisted vitrectomy during management of retained nuclei with phacofragmentation. SETTING: Dokuz Eylul University, Medical Faculty, Ophthalmology Department, and Retina Eye Center, Izmir, Turkey. METHODS: Twelve eyes of 12 patients were operated on between January 2002 and September 2003. Eleven patients were referred because of nucleus drop during phacoemulsification surgery. Six of these patients had mature white cataracts, and in 5 cases total nucleus luxation into vitreous cavity had occurred. In 1 case, approximately half of the nucleus was luxated. Five of the referred patients had pseudoexfoliation (PEX), 3 of whom also had phacodonesis. All of these patients had luxated nucleus segments of more than half. One patient was referred with an intraocular lens (IOL) implanted in the sulcus region. One patient who was not referred also had PEX, iridodonesis, and phacodonesis; total drop of nucleus had occurred in this case. All patients were treated with pars plana vitrectomy with triamcinolone acetonide staining of the vitreous material and phacofragmentation of the dropped nucleus segments. In 2 cases, transscleral foldable IOL fixation surgery was combined simultaneously. One patient already had an IOL at the time of referral. Nine patients were left aphakic for secondary procedures. RESULTS: All patients except 1 with subretinal neovascular membrane achieved best corrected visual acuities of equal or better than 0.5. No intraoperative or postoperative retinal complications were observed after 9 to 15 months of follow‐up. CONCLUSION: Staining of the vitreous material with triamcinolone acetonide during vitrectomy and phacofragmentation surgery for luxated nuclei helped in total removal of the vitreous body, thus preventing the aspiration of peripheral vitreous fibrils by the phaco tip, which might induce retinal detachment intraoperatively or postoperatively.

Colour Doppler Assessment of Blood Flow in Eyes with Central Retinal Vein Occlusion

Purpose: To assess the blood flow changes in eyes with central retinal vein occlusion (CRVO) and compare these values with values of fellow eyes and eyes of normal subjects. Methods: 25 eyes of 25 consecutive newly diagnosed patients with CRVO comprised the study group. Their fellow eyes and those of 25 healthy subjects were the control group. All patients underwent a complete ophthalmological examination. Eyes with CRVO were classified into two groups as non-ischaemic and ischaemic by fundus fluorescein angiography. Colour Doppler imaging was performed with a Toshiba Sonolayer SSH-140A and 7.5-MHz linear array probe. Maximum systolic velocity (Vmax), end-diastolic velocity (Vmin) and resistive index (Ri) values were noted for each of the central retinal artery (CRA), central retinal vein (CRV) and ophthalmic artery (OA). These parameters were compared with those of the fellow eyes and both eyes of the control group. Results: Mean ages were 63.55 and 61.45 years in the CRVO and control groups, respectively. Age and sex distributions were statistically identical in both groups. When we compared the eyes with CRVO to the control group, no statistically significant difference existed between the two groups with regard to the Vmin and Ri values of the CRA and CRV. However, Vmax values of the CRA and CRV were significantly lower in CRVO eyes when compared to the control group. The CRVO group and control group had similar Vmax, Vmin and Ri values for the OA. Only the Vmax was significantly lower in the CRV in eyes with CRVO when compared to the unaffected fellow eyes. No statistically significant difference could be detected between any of the parameters of CRA, CRV and OA of the ischaemic and non-ischaemic CRVO groups. Conlusions: More data on broader series need to be obtained in order to decide on the practical use of colour Doppler imaging in the differentiation of ischaemic eyes from non-ischaemic eyes in CRVO.